Outline

Objective

Surgical manipulation of the fifth cranial nerve during its intra- or extracranial course may lead to patient’s bradycardia or even asystolia along with arterial hypotension, a phenomenon described as the trigeminocardiac reflex (TCR). We study the impact of this reflex on postoperative auditory function in vestibular schwannoma surgery.

Results

The TCR, which occurred in 11% of the patients, influenced the postoperative hearing function in the patients with T3 and T4 vestibular schwannomas. With an overall hearing preservation of 47%, 11.1% of the TCR group and 51.4% of the non-TCR group showed preserved hearing function, postoperatively. In larger tumors (T3 and T4), patients with an intraoperative TCR had a significantly worse postoperative hearing function than those without a TCR during vestibular schwannoma surgery (p=0.005).

Conclusions

The hypotension following TCR is a negative prognostic factor for hearing preservation in vestibular schwannoma surgery. Referring to this knowledge patients’ information can be increased pre- and postoperatively. Further study of this phenomenon will advance the understanding of the underlying mechanisms and may help to improve hearing preservation by controlling the occurrence of the TCR.